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Perioperative Pharmacologic Management of Patients with End Stage Renal Disease
Author(s) -
Karambelkar Ameet,
Kasekar Riyaj,
Palevsky Paul M.
Publication year - 2015
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/sdi.12384
Subject(s) - medicine , perioperative , pharmacokinetics , dialysis , end stage renal disease , intensive care medicine , volume of distribution , drug , disease , pharmacology , anesthesia
Abstract The pharmacokinetics of numerous medications used in the perioperative period are altered in patients with end‐stage renal disease. Clearance of drugs, or their metabolites, that are normally excreted by the kidney is markedly reduced in ESRD . In addition, patients with ESRD may also have alterations in gastrointestinal absorption, volume of distribution, protein binding, and metabolic clearance of pharmacologic agents. Finally, drug removal may be augmented during dialysis. All of these factors contribute to the need for dose adjustment of medications, including analgesics, anesthetics, neuromuscular blockers, and antimicrobial agents, which may be used in the perioperative management of the ESRD patient.